SUPERIOR COURT OF CALIFORNIA
              COUNTY OF ____________________

In the Matter of the           |  NO. ____________________
Application of                 |
YOUR BIRTH NAME,               |  PETITION FOR CHANGE OF
                  Petitioner,  |   NAME AND NEW BIRTH
For Change of Name and         |  CERTIFICATE
New Birth Certificate          |
_______________________________|


 Petitioner, (BIRTH NAME), [also known as _____,]
alleges:

 1. Petitioner is over 18 years of age.

 2. Petitioner resides at (street address and city),
(County), California.

 3. Petitioner was born at (place of birth), California,
on (date). The birth was recorded in state records showing
petitioner's present name as (birth name) and petitioner's
sex as (male or female).  A copy of petitioner's birth
certificate is attached hereto as Exhibit A and made a part
hereof.

 4. Petitioner's proposed name is (Proposed Name).

 5. The reason for the proposed name change and the new
birth certificate is that petitioner has undergone surgery
for the purpose of alter petitiner's sexual characteristics
to those of a (male or female).  A physician's affidavit (or
declaration - as appropriate) documenting the sex change is
attached hereto as Exhibit B and made a part hereof.

                        [EITHER]
 6. Petitioner's parent is (Name), who resides at
(street address, city, and state).
                          [OR]
 6. Petitioner's parents are both deceased.  The names
and places of residence of near relatives of petitioner, as
far as known to petitioner, are as follows:
Name			Relationship		Residence
_________________	__________________	____________
_________________	__________________	_____________

 WHEREFORE, petitioner prays as follows:

 1. For an order to show cause at a specified time and
place why this petition should not be granted;

 2. That, on the hearing, the court make an order
changing petitioner's name from (birth name) to (proposed
name).

 3. That, on the hearing, this court make an order for
issuance of a new birth certificate reflecting the change of
petitioner's sex and name for filing in state records in
lieu of the original record of petitioner's birth; and

 4. That all other proper orders be granted.

Dated:____________________

     ____(Signature)_________
     Petitioner